Responding to unique client needs is an ongoing challenge for mental health and substance use practitioners. At MNCAMH we aim to provide you with evidence-based practical tips. MNCAMH has several recommendations that align with practices encouraged by nationally recognized institutions and the Substance Abuse and Mental Health Services Administration (SAMSHA) and the National Institute on Drug Abuse (NIDA).

Practitioners should make time to ask about both mental illness and substance use symptoms.

Complete, thorough assessment

  • Talk about past substance use first before moving onto current use. This can help your client ease into this conversation if motivation is low or if the client becomes defensive.
  • Mental health history helps determine if substance use began as a way to manage mental illness symptoms OR if mental illness symptoms were made worse by substance use.

Use motivational strategies to engage a client

Clients can enter treatment with indecision about making lifestyle changes.

  • Evaluate pros and cons of staying the same versus making positive changes.
  • “On one hand… yet on the other hand…” draws contrast between why the client might want to continue the same behavior while pointing out a reason to change the behavior.

Choose interventions based on client’s stage of change

  • Working knowledge of stages of change and accompanying stages of treatment can help build you meet your client where he or she is at.
  • Allowing for harm reduction strategies can keep clients engaged and motivated.

Use risk reduction and stabilization

Clients’ willingness to change substance use behavior is likely to evolve more slowly when mental illness is involved and vice versa. “Keeping it on the table,” a technique endorsed in Enhanced Illness Management and Recovery (E-IMR) can help you and your client navigate change collaboratively.

  • Present options besides an abstinence-only approach to retain more clients and allow ongoing substance use reduction.
  • Help your client talk about substance use openly by avoiding confrontation such as criticism, shaming, or coercion.
  • Removal of high risk behaviors (e.g., drinking and driving, sharing needles) are seen as treatment successes and will help build your client’s self-esteem.

Adjust perspective on treatment timeframe

Clients with COD will typically have a longer course of treatment than clients without. Patience and empathy are key to working through setbacks with your client.

  • Be assertive in keeping client engaged in treatment activities. Make your treatment plan a “living document.”
  • Be willing to review skills learned in the past. Help your client see this as a normal part of successful treatment.